Qualitative Health Research Research Articles

Theoretical and methodological aspects in qualitative research in health

Theoretical and methodological aspects in qualitative research in health

“And Then COVID Hit”: (Re)flexibility of Digital Storytelling in Qualitative Health Research

The purpose of our qualitative health research study was to understand the experiences of Ontarians who accompanied someone throughout their dying process using medical assistance in dying (MAiD). The second phase used digital stories as a method to examine and share these experiences at the end of life. And then the COVID-19 pandemic hit, and we faced a pivot to our original plan. This pivot resulted in reinforcing the myriad benefits of using digital storytelling in qualitative health research. And rather than detracting from the initial study, we also learned that digital storytelling is a flexible method that can be creatively, compassionately, and effectively conducted in virtual spaces. We will employ digital storytelling in future qualitative health research as both a component of studies but also as a conduit for explorations of other tools of data collection and dissemination.

Refugee and migrants' involvement in participatory spaces in a US practice-based research network study: Responding to unanticipated priorities.

Refugees and migrants face suboptimal involvement in spaces for primary healthcare decision-making. Given the rising numbers of resettled refugees and migrants in primary care settings in the United States, there is an urgent need for patient-centred outcome research in practice-based research networks (PBRNs) with diverse ethnolinguistic communities. This study explored whether researchers, clinicians and patients would achieve consensus on (1) a common set of clinical problems that were applicable across a PBRNand (2) potential clinical interventions to address those problems to inform a patient-centred outcomes research (PCOR) study in a similar research network. In this qualitative participatory health research study, patients from diverse ethnolinguistic communities and clinicians from seven practices in a US PBRN discussed preferences for PCOR responsive to patients and the clinicians who serve them in language-discordant settings. Researchers and an advisory panel that included patients and clinicians from each participating practice held regular advisory meetings to monitor progress on project milestones and solve emerging problems. Participants took part in 10 sessions using Participatory Learning in Action and the World Café methods to identify and prioritise their ideas, using questions set for them by the advisory panel. Data were analysed based on principles of qualitative thematic content analysis. Participants identified common barriers in language-discordant healthcare settings, principally patient-clinician communication barriers and suggestions to overcome these barriers. A key finding was an unanticipated consensus about the need for attention to healthcare processes rather than a clinical research priority. Negotiation with research funders enabled further analysis of potential interventions for care processes to improve communication and shared decision-making in consultations and the practice as a whole. PCOR studies should examine interventions for improving communication between patients from diverse ethnolinguistic communities and primary care staff if the sorts of harms experienced by patients experiencing language-discordant healthcare are to be reduced or prevented. Flexibility and responsiveness from funders to unanticipated findings are key structural supports for participatory health research in primary care clinical settings with this population and others who experience marginalisation and exclusion. Patients and clinicians participated in the study both in the formulation of the study question, data collection, analysis and dissemination of these results; consented to their individual participation;and reviewed early drafts of the manuscript.

Ethical Issues when Using Digital Platforms to Perform Interviews in Qualitative Health Research

Qualitative studies have become increasingly common and have been used in different fields such as economics, politics, psychology, sociology and health research for different purposes. Instead of collecting numerical data, qualitative research’s goal is to gather information from participant’s experiences and perceptions. One of the tools to get data related to the participants’ experiences in qualitative research is through interviews. One tool that may be helpful for researchers today are digital and video platforms that fall under the domain of the internet-mediated research. The aim of this work is to identify and describe some ethical controversies when using videoconferencing platforms in qualitative health research for interview purposes. Four cases related to the use of digital platforms (videotelephony systems) to conduct interviews in qualitative research were discussed. Rather than give solutions, we reflect upon the possibility and plausibility of using these telecommunication technologies when using the technique of interviews in qualitative research. The ethical issues that may arise when using these technologies are related to privacy, confidentiality, accuracy of information and expertise when using the platforms. We think that the researcher is committed to making the best decisions in favor of the participant when using digital tools to gather information. In this regard, qualitative researchers may be benefited by the reflections we present insofar they may consider these possible scenarios that may rise ethical issues when collecting data. The activity of research needs to be escorted by constant ethical deliberations to protect participants’ rights during the collection of data phase.

Qualitative public health research published in Colombian biomedical journals between 2011 and 2021

Introduction: Qualitative research seeks to understand the meaning and perspective of individuals and investigates considering the context. This paradigm allows the interpretation and study of phenomena from their own complexity. In public health, qualitative research has gained ground, as it allows the study of subjective aspects of the health-disease process. Objective: To describe and analyze qualitative research on health issues published in Colombian journals between 2011 and 2021. Materials and methods: A descriptive study on qualitative health research published in Colombian journals between 2011 and 2021 was carried out. Results: Eighty-one articles were included. The journal with the highest number of publications was the Revista de Salud Pública (44.4%). The year with the highest production corresponded to 2019 and the main design was the fundamental theory (17.3%). In 79% of the articles, women were the main author and nursing was the most frequent profession of undergraduate training. The most frequent topic was HIV/AIDS (12.3%), followed by cancer (11.1%). In 24.6% of the studies, a software was used for the analysis. Conclusions: Qualitative research in public health has had a variable dynamic in scientific production between 2011 and 2021. Despite its benefits, the adoption of computer programs for qualitative analysis is rare. Nursing stands out as the area that concentrates the largest number of qualitative studies in public health with contributions on topics such as COVID-19 and HIV/AIDS.

Superwoman schema: uncovering repercussions of coping strategies used among Black women at high risk for HIV

ABSTRACT The Superwomen Schema (SWS) describes a social framework that encompasses the role that many Black women adopt in response to chronic stress, financial pressures, and an intersection of oppression. Woods-Giscombé (Superwoman Schema: African American Women’s Views on Stress, Strength, and Health. Qualitative Health Research 20 (5): 668–683, 2010) characterizes SWS using five tenets: obligation to manifest strength, obligation to suppress emotions, resistance to vulnerability or dependency, determination to succeed despite a lack of resources, and an obligation to help others. The goal of this study is to determine the connection between SWS among Black women and substance use as a means of maintaining mental health, garnering resilience, and coping with external pressures. We aimed to highlight systemic and infrastructural racism and prejudice and how they relate, not only to the adoption of SWS, but also how they may contribute to substance use. This study is a secondary analysis of a larger study on HIV prevention Black and Latine women at high risk for HIV. Only Black participants (n = 10) were included in this secondary analysis. The interviews were conducted 3 times across 3 months. Interviews were coded and analyzed using thematic content analysis in NVivo. Themes of undiagnosed mental health symptoms, medical mistrust, institutional distrust, and aversion to help-seeking were recurrent in our data. Our research confirmed and assessed dual repercussions of SWS among Black women both as a defense that granted resilience in the face of seemingly insurmountable odds and as a construct that encouraged substance use as a coping mechanism for compromised mental health. This study contextualized this subset of coping and substance use to address and dismantle systemic contributors.

Introducing SAMMSA, a Five-Step Method for Producing 'Quality' Qualitative Analysis.

Qualitative health research is ever growing in sophistication and complexity. While much has been written about many components (e.g. sampling and methods) of qualitative design, qualitative analysis remains an area still needing advanced reflection. Qualitative analysis often is the most daunting and intimidating component of the qualitative research endeavor for both teachers and learners alike. Working collaboratively with research trainees, our team has developed SAMMSA (Summary & Analysis coding, Micro themes, Meso themes, Syntheses, and Analysis), a 5-step analytic process committed to both clarity of process and rich 'quality' qualitative analysis. With roots in hermeneutics and ethnography, SAMMSA is attentive to data holism and guards against the data fragmentation common in some versions of thematic analysis. This article walks the reader through SAMMSA's 5 steps using research data from a variety of studies to demonstrate our process. We have used SAMMSA with multiple qualitative methodologies. We invite readers to tailor SAMMSA to their own work and let us know about their processes and results.

A framework for selecting data generation strategies in qualitative health research studies.

Qualitative health research has the potential to answer important applied health research questions to inform nutrition and dietetics practice, education and policy. Qualitative health research is a distinct subdiscipline of qualitative inquiry that purposefully draws upon the context of healthcare and emphasises health and wellness. Qualitative health research is defined by two parameters: (1) the focus of the study and (2) the methods used. When considering the methods to be used, decisions are required about the type of data to be generated (e.g., transcripts, images and notes) and the process involved in data generation (e.g., interviews, elicitation strategies and observations) to answer the research question(s). Drawing upon examples from nutrition and dietetics literature, this paper provides a framework to support decision-making for nutrition and dietetics researchers and clinician researchers designing conducting qualitative health research. The guiding questions of the framework include: What types of data will be generated? Who is involved in data generation? Where will data generation occur? When will data generation occur? How will data be recorded and managed? and How will participants' and researchers' emotional safety be promoted? Questions about the types of data, those involved, where and when, as well as how safety can be maintained in data generation, not only support a more robust design and description of data generation methods but also keep the person at the centre of the research.

Methodological Insights, Advantages and Innovations Manuscript Title: Lessons Learned in Conducting Qualitative Healthcare Research Interviews in Malawi: A Qualitative Evaluation

With the growth of qualitative health research in low- and middle-income countries, local health professionals are increasingly involved in facilitating interviews with their fellow health workers. Understanding the methodological implications of such situations is required to ensure high-quality study findings and to build capacity and skills for interviewers with clinical backgrounds working with limited resources. This article reports a qualitative process evaluation of a study that assessed barriers and enablers of implementing bubble continuous positive airway pressure in Malawi. Findings were summarized through an iterative process of reflection on what worked, what did not work, areas for improvement, structural challenges, negotiating dual roles as nurses and researchers and the professional hierarchy within the health care system. Comprehensive practical training was critical to conducting qualitative research in a health setting. Interviewers were health workers themselves and required skills in reflexivity to effectively probe and navigate interviewing other health professionals, including senior staff. The main challenge in conducting interviews in a resource-limited healthcare setting was time constraints, which were compounded by staffing shortages. Lessons from this qualitative evaluation highlight the importance of training in reflexivity, engaging interviewers as collaborators and reserving adequate time to accommodate healthcare workers’ multiple roles and responsibilities.

Promoting the Participation of "Hard-to-Reach" Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile.

The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit "hard-to-reach" international migrants for qualitative public health research during the pandemic in Chile, based on the authors' experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.

Critical Reflections on Conducting Qualitative Health Research During COVID-19: The Lived Experiences of a Cohort of Postgraduate Students in a South African University.

COVID-19 ushered in public health guidelines restricting face-to-face contact and movement, and encouraging social distancing, all of which had implications for conducting field-based research during the pandemic. For qualitative researchers, this meant adapting conventional face-to-face methods and resorting to virtual variations of the same in adherence to stipulated COVID-19 health protocols. Virtual qualitative research introduced new concerns and logistical challenges. This paper presents critical reflections on experiences of conducting qualitative research during the pandemic, from the perspectives of a cohort of postgraduate fellows. A critical reflection framework was utilised to explore fellows experiences and meanings ascribed to their experiences. The research findings illustrate three overarching processes which, in turn, shaped ways of thinking, doing and being. First, explicating tacit assumptions about their anticipated research journeys and interrogating these. Second, shifts in power differentials demonstrated by role reversal between researchers and participants, and between fellows and supervisors as they re-negotiated their positionalities in virtual research spaces. Third, context specific sense-making, in which - narrative accounts support the notion of knowledge as a social construct. Our findings have important implications for qualitative research practice. Our study documents methodological nuances and social implications of conducting qualitative research during COVID-19 and in a-South African context. In addition, our study exemplifies the use of critical reflection in qualitative research practice in the specific context of postgraduate academic research. Further, our study illustrates how the use of technology shapes qualitative research protocol development, data collection and analysis phases.

Intersectional Principles of Community Partnership and Social Justice in Qualitative Research in Migration

This article examines the methodological implications of employing intersectional principles in qualitative health research conducted in migration contexts, specifically focusing on a doctoral research project on return migration and reunited couples in Mexico. The article highlights the integration of social justice and community-based research perspectives within an intersectional lens. Five key areas are examined, including recognizing diversity and agency among women who stay behind, navigating intersectional identities, understanding positionality, and advocating for populations made vulnerable by inadequate policies, navigating power dynamics and multiple social locations, and empowering the community through intersectional research. The application of intersectionality challenges homogenizing narratives, emphasizing the agency and resilience of women who stay behind. Reflexivity is crucial in mitigating biases and deepening insights, while collaboration with a local researcher enhances understanding of power dynamics. By empowering the community through advisory committees and culturally relevant dissemination, I aimed to amplify community member voices and promote social justice. This article serves as a valuable resource for researchers conducting intersectional qualitative health research in rural settings, offering guidance on integrating a strength-based approach, fostering intersectional reciprocity, and navigating positionalities.

Photo Elicitation Interviewing Enriches Public Health Research on Fathers’ Role in Child Care and Feeding in Addis Ababa, Ethiopia

Photo elicitation interviewing (PEI), as a visual qualitative research methodology, has been used widely in various fields with different participants. However, little has been written about using the method in public health research, especially involving men in low-income settings. In this paper, the authors reflect upon the use of PEI in a study that explored fathers’ experiences in child care and feeding in a low-income neighbourhood of Addis Ababa city in Ethiopia. The reflections focus on two overarching themes; (1) how PEI worked well as an effective technique in terms of addressing the research questions posed in this low-resourced setting and (2) how it served to enhance phenomenology in qualitative public health research. The researchers also discuss the limitations and lessons from employing this methodology through continuous reflexivity, which is valuable to qualitative work.

Getting to the heart of the matter: a research partnership with Aboriginal women in South and Central Australia

ABSTRACT Within the vast majority of qualitative health research involving Indigenous populations, Indigenous people have been marginalised from research conceptualisation and conduct. This reflects a lack of regard for Indigenous ways of knowing, being, and doing, has served to perpetuate deficit narratives of Indigenous peoples’ health and wellbeing, and contributes to failure in addressing inequities as a result of ongoing colonisation and institutionalised oppression and racism. There is a need to place Indigenous voices and ways of doing at the centre of research by working in intercultural partnership, bringing together Indigenous and Western knowledges. This paper explores how such an approach can be applied, demonstrating a reflective process of conceptualisation and conduct that brings together Indigenous ways of working with grounded theory with Aboriginal communities in Australia. Furthermore, it supported a non-Indigenous researcher to learn ways of working respectfully, guided by community protocols. A six-stage research process was developed, overseen by an Aboriginal Women’s Advisory Group. Research conceptualisation and conduct centred on three principles: bringing together Aboriginal ways of working with Western research methodology; using women’s own voices to develop a narrative of cardiovascular health and wellbeing; and ensuring that tangible outcomes were delivered to women and communities in the spirit of partnership and reciprocity. This approach, guided at all steps by Indigenous women, demonstrates a way of adapting qualitative Western methodology to ensure values and principles of ethical guidelines of conduct are upheld to unravel constructs of colonisation, redress past wrongdoing, and reverse deficit narratives.

Social desirability bias in qualitative health research.

The objective of this essay is to discuss the social desirability bias in qualitative health research. The social desirability bias consists of a systematic research error, in which the participant presents answers that are more socially acceptable than their true opinions or behaviors. Qualitative studies are very susceptible to this type of bias, which can lead to distorted conclusions about the studied phenomenon. Initially, I present the theoretical-conceptual aspects of the social desirability bias. I discuss how its occurrence can be intentional or unintentional, with a distinction between the concepts of self-deception and impression management. Then, I discuss the determining factors of this bias from four dimensions: study design; study context; interviewee's characteristic; interviewer's posture. Finally, I present a systematization of six strategies to be used by qualitative researchers for identifying and controlling social desirability bias.

The Unspoken Voice: Applying John Shotter's Dialogic Lens to Qualitative Data from People Who have Communication Difficulties.

As speech and language therapists, we explored theories of communication and voice that are familiar to our profession and found them an inadequate basis on which to generate deep and rich analysis of the qualitative data from people who have communication difficulties and who use augmentative and alternative communication. Expanding our conceptual toolkit to include the work of John Shotter allowed us to reconceptualise voice and where it is emergent in dialogue. Reimaging voice will inform clinical and research praxis with people who have communication difficulties as it allows practitioners to attend more closely to the complexity and nuance inherent in interactions with this population. Our proposition is exemplified with excerpts from a single participant who has communication difficulties to illustrate the value of dialogic theory in praxis. This article presents a provocation for the wider academy of qualitative health research; do we have the concepts and tools to develop meaning with people whose lived experiences may also be hard to voice in monologues?

Talent development environments within sports: a scoping review examining functional and dysfunctional environmental features

ABSTRACT Based on the work of Martindale, R. J., Collins, D., and Daubney, J. (2005, Talent development: A guide for practice and research within sport. Quest (Grand Rapids, Mich ), 57(4), 353–375. https://doi.org/10.1080/00336297.2005.10491862) and Henriksen, K., Stambulova, N., and Roessler, K. K. (2010a, Holistic approach to athletic talent development environments: A successful sailing milieu. Psychology of Sport and Exercise, 11(3), 212–222. https://doi.org/10.1016/j.psychsport.2009.10.005), researchers have increasingly focused on environmental features influencing talent development in sport from an integrated, holistic perspective. These contributions led to a quickly evolving body of literature and a proliferation of findings related to facilitative and debilitative environmental features. With a timely appraisal of this work warranted, this review aims to coalesce salient results from talent development environment research. For this purpose, a holistic perspective is employed on (a) the environmental level, by considering the sport and non-sport domain and by identifying functional and dysfunctional features, as well as on (b) the outcome level, by considering wellbeing and personal development, alongside athletic development, as important athlete-related outcomes. Following a systematic search, 44 articles were identified and findings summarised by conducting a directed content analysis (Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687). Several functional and dysfunctional features were derived from the literature and grouped into the following main categories within a preliminary conceptual framework: Preconditions of the Sport Environment, Organisational Culture, Integration of Efforts, and Holistic Quality Preparation. The framework’s contribution to a more systemic and holistic approach to talent development is discussed and critical future research directions are proposed.

Co-production to understand online help-seeking for young people experiencing emotional abuse and neglect: Building capabilities, adapting research methodology and evaluating involvement and impact.

Involving young people (YP) as co-researchers (YCoR) in mental health research is important for ethical and epistemological reasons. However, approaches to involve and evaluate 'meaningful involvement' in complex qualitative mental health research, and how to evaluate impacts (or change) for the co-researcher and the research is less well defined. This co-produced research explored the experiences of YP seeking help for emotional abuse and neglect via an online, peer-peer message board. This practical case study aims to evidence the meaningful role and impacts associated with YCoR involvement in sensitive and complex mental health research using a flexible approach to co-production. During the Covid-19 pandemic, we explored on- and off-line approaches and adapted research methodology to build relationships, knowledge, skills, and confidence withYCoR. The virtual involvement was evaluated against the five principles of co-production. Anonymous, continuous digital feedback, reflective practices and multiple dissemination outputs are used to evaluate the impact of the study on those involved and the research. Ten members of NeurOX Young People's Advisory Groupwere involved in the core project. Additional members were invited at later stages and in the dissemination of outputs. We describe a supportive, scaffolded learning approach to build capabilities and embed the lived experience of YCoR in complex qualitative research. A digital blended approach was acceptable to YCoR, principles of co-production were met and the impact/benefits of involvement are described. To demonstrate the epistemological value of involving YP we evidence YPs capabilities for involvement and the 'change' or contribution YCoR made to the research through reflective practices. This case study demonstrates how flexible approaches co-production with YCoR can be robust and responsive to balance ethical and epistemological impact in complex mental health research. Supportive, scaffolded practices and safe environments helped build the confidence and capacity of YCoRs to demonstrate valuable phenomenological insights in the analysis. YP's perspectives on how they describe 'meaningful' and impactful involvement illustrate the reciprocal benefits gained through working together. This case study describes the YCoR involvement throughout the research and dissemination of outputs. YCoR co-authors were involved in developing the outline and reviewing the draft stages of the manuscript.

Kawaii Affective Assemblages

Kawaii Affective Assemblages

Rapid qualitative health research from the Global South: Reflections and learnings from Argentina, Brazil, Chile, and Mexico during the COVID-19 pandemic.

The objective of this paper is to provide insights into our experiences undertaking qualitative rapid research in Latin American contexts based on fieldwork from Argentina, Brazil, Chile, and Mexico. We focus on the insights and learning processes that emerged from our research teamwork during the COVID-19 pandemic. Our research projects are part of an international collaboration led by the Rapid Research Evaluation and Appraisal Lab (RREAL) to explore the experiences of COVID-19 Frontline Healthcare Workers. The analyzed experiences not only rely on the local studies but also on our reflections as a group of Latin American researchers collaborating along with an international team. Qualitative research has an important and long-lasting tradition in Latin America. However, healthcare professionals are still reluctant to use these methods. We highlight tensions and dilemmas that have emerged from our own empirical experience: First, the time for research ethics committees to evaluate the protocols; second, the difficulties in accessing funding to undertake research due to the lack of financial opportunities; third, having to decide the language of our publications. That is just the tip of the iceberg that allows us to show inequalities in the conditions under which scientific knowledge is produced between the North and the Global South. Following these points, our text explores the tension between the urgency to conduct rapid research and the multiple difficulties when undertaking it during the pandemic. It is important to point out that the problems we faced already existed before the sanitary emergency, being magnified by the former. At last, our conclusions delve into the reflexive process we, as a team of female researchers, undertook to explore the differences and similarities of our experiences. This analysis allowed us to solve obstacles and dilemmas when doing research. The winding road we describe here serves as an example for other research teams when planning and undertaking rapid qualitative research during future pandemics.